The correct diagnosis and management of patients with uterine inversion will always remain as a challenge to any obstetrician. Two cases of puerperal uterine inversion managed differently are presented. In the first patient, there was delay in the diagnosis of uterine inversion and patient had to undergo hysterectomy. In contrast, there was early recognition of uterine inversion in the second patient prompting immediate manual repositioning.

Human ; Female ; Young Adult ; Adolescent ; Uterine Inversion ; Hysterectomy ; Obstetric Labor Complications

Background: Current medical management of endometriosis leads to suppression of ovulation and will not be helpful for women with endometriosis who are desirous of pregnancy. Thus, drugs that can both treat endometriosis and its associated infertility are highly warranted. Objective: Anti-angiogenic agents are potential drugs for patients with endometriosis and infertility. Among these drugs, dopamine agonist (DA) is promising since it does not interfere with ovulation, is safe, and not teratogenic. The aim of the study is to determine the efficacy and safety of DA for improving reproductive outcomes in women with endometriosis and infertility. Methods: A qualitative narrative review was done from inception to July 31, 2022 using the appropriate MeSH terms in PubMed, Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, ClinicalTrial.gov, and World Health Organization International Clinical Trials Registry Platform. Date analysis was through qualitative analysis and synthesis of researches and their outcome measures. Results: No studies used the core outcomes for trials evaluating treatments for infertility associated with endometriosis. All the included articles in the review supported the possible anti-angiogenic effects of DA on the vascular endothelial growth factor [VEGF] /VEGF receptor system. The use of DA does not have an effect on ovulation and menstrual cyclicity. Studies on safety profile of DA were consistent with existing data. Conclusion Most of studies reviewed demonstrated that DA were effective in reducing endometriotic lesions. However, further research is required to establish whether this anti-angiogenic effect can improve reproductive outcomes in women with endometriosis-associated infertility.
Endometriosis ; Dopamine Agonists ; Infertility ; Angiogenesis Inducing Agents ; Angiogenesis Inhibitors

Background and Objective: Diabetes, a prevalent metabolic disorder characterized by hyperglycemia primarily due to insulin action and secretion, poses significant health challenges, particularly in low to medium-income countries such as the Philippines. Quassia amara, a shrub indigenous to South America and present in the Philippines, holds a rich history of utilization in alternative and complementary therapies. While previous studies have demonstrated the hypoglycemic effects of Quassia amara stem wood, investigations into the potential impact of its leaves on blood glucose levels remain scarce. Thus, this study aimed to assess the blood glucose-lowering effects of the aqueous leaf extract of Quassia amara (ALQa) on ICR strain mice. Methods: Diabetes was induced in thirty male ICR mice via intraperitoneal administration of alloxan monohydrate (200 mg/kg) dissolved in 0.9% Normal Saline. The mice were divided into five groups (n=6), Group I: negative control (distilled water), Group II: reference standard glibenclamide (4 mg/kg): Groups III-V: three doses of ALQa (125, 250, and 500 mg/kg) via oral gavage. A glucometer was used to monitor the fasting blood glucose levels at 0, 1-, 2-, 6-, and 24-hour postadministration. Results: Administration of alloxan monohydrate increased the FBS in the treated group to diabetic levels of >200 mg/dL. The treatment of diabetic mice with ALQa extract significantly reduced fasting blood sugar (FBS) levels in a dose-dependent manner with the highest dose of ALQa (500 mg/kg) having glucoselowering effects comparable to glibenclamide beginning with the 2-hour mark until 24-hour post-intervention. The mean FBS at 0-hour (baseline) and 1-hour postintervention were similar for all the groups. However, there was an increase in the mean FBS of the negative control group treated with distilled water in the first hour while there was already a decrease in the FBS of those allocated to glibenclamide and the three doses of ALQa. At both the second and 6-hour mark post-intervention, the mean FBS of the mice treated with ALQa 250 mg/ kg and 500 mg/kg was comparable to glibenclamide. Finally, at the 24th hour post-intervention, only the mice allocated to 500 mg/kg of ALQa had comparable FBS to glibenclamide. The degree of reduction [mean percent reduction] of the FBS from baseline to the 24th hour was 78% for glibenclamide and 69% for ALQa 500 mg/kg (p =0.816). Conclusions The aqueous extract of Quassia amara leaf at 250 and 500 mg/kg produced a dose-dependent significant blood glucose-lowering effect in the alloxan-induced diabetic mice model. The 500 mg dose demonstrated a statistically comparable reduction in FBS to glibenclamide from the 2-hour time point. These f indings suggest the potential of ALQa as an antidiabetic agent. Thus, warranting further investigation into its therapeutic mechanisms and clinical applications.
Quassia amara ; Quassia

Objectives: The Bioavailability/Bioequivalence Unit (BA/BE Unit) of the Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines Manila which has not been operational since 2012, is due for renewal of its accreditation. To date, there are only three Philippine Food and Drug Administration-accredited laboratories that perform bioequivalence studies in the Philippines. One of the prerequisites of registering specific generic medicines is the conduct of Bioequivalence (BE) studies which are performed to ensure that the generic drug is at par with the innovator drug. Thus, this study aimed to determine the feasibility of re-establishing the BA/BE Unit as a bioequivalence testing center. Methods: The feasibility study done is a qualitative descriptive analysis based on expansive literature review and performance of SWOT analysis within the BA/BE unit. Literatures were selected based on its assessed relevance to the study. The databases checked were PubMed and Google Scholar. The terms used were from the Medical Subject Heading (MeSH) including feasibility studies, therapeutic equivalency, and generic drugs. Literature review was performed on the factors affecting the four types of feasibility studies (market, technical, financial, and organizational). A SWOT analysis of the BA/BE Unit was done through the review of records and documents of previous BE studies and focus group discussion among the BA/BE Unit team members. Results: The BA/BE Unit conducted 24 bioequivalence studies from 2006-2009 and still receives inquiries from drug companies. It implements its QMS throughout the pre-analytical, analytical, and post-analytical stages of the workflow. Its organizational structure consists of qualified professionals with updated GCP and GLP certificates. Because of the adequately equipped facility, lower honoraria for government-employed personnel, and lower expenses for laboratories and in-patient admissions, the cost of conducting a bioequivalence study in the BA/BE Unit will be lower than in other BE centers. Conclusion Based on the SWOT analysis and market, technical, financial, and organizational considerations, reestablishing the BA/BE Unit as a bioequivalence testing center is feasible.
Feasibility Studies ; Therapeutic Equivalency ; Drugs, Generic